IR( interventional radiology)-3

Hysterosalpingogram:-

Hysterosalpingogram is used to do to examine the cavity of the uterus and fallopian tubes. In this contrast, the material is injected through a tube through the vaginal into the uterus. Series of X-rays taken as the dye moves from the uterine cavity through fallopian tubes. If the fallopian tube is normal that dye will flow out through the tube into the abdominal cavity and it will absorb by the abdomen. This test usually takes 15 to 30 minutes and is performed by a radiologist or a gynecologist in the radiology department of the hospital.

It is performed for the diagnosis of infertility.

It is also performed to determine whether surgery performed to reverse the tubal ligation has been successful…

Hysterosalpingogram (HSG)

Product/Service

Code

Description

Essure procedure

58565

Hysteroscopy, surgical; with bilateral fallopian tube cannulation to induce occlusion by the placement of permanent implants

Modified HSG

58340

Catheterization and introduction of saline or contrast material for saline infusion sonohysterography (SIS) or HSG

Modified HSG, interpretation, and supervision

74740

HSG, radiologic supervision, and interpretation

Modified HSG, interpretation

74740-26

HSG, radiologic supervision, and interpretation, a professional component only

Modified HSG, supervision

74740-TC

HSG, radiologic supervision, and interpretation, a technical component only

TVU

76830

Ultrasound: Transvaginal

1. Sample Report:

History: A 31-year-old with polycystic ovarian disease. The patient has been trying to get pregnant for 10+ years. Technique: The risks and benefits of the procedure were explained in detail to the patient and the patient was placed in a supine position on the fluoroscopy table. The external genitalia was prepped with Betadine. A speculum was introduced into the vagina and the cervix was identified. The cervix was prepped with Betadine. A balloon-tipped catheter was inserted through the cervical os with the balloon inflated just inside the endometrial cavity. Real-time fluoroscopic images were obtained of the pelvis as a small amount of nonionic contrast was instilled through the catheter. The patient tolerated the exam without complication.
Findings (Interpretation): Initial precontrast images demonstrate no radiopaque foreign body within the pelvis. The endometrial cavity has a normal contour. Both fallopian tubes fill with the instilled contrast.
There is free spillage of the contrast bilaterally from the fallopian tubes into the pelvic cavity.

Impression: Hysterosalpingogram appears within normal limits. Both fallopian
tubes appear to be patent on this exam.

2. Sample Report:

US HYSTEROSONOGRAPHY

Uterine catheterization was done in the usual fashion, and vaginal sonography is done both with the balloon distended with saline and with the balloon deflated. Sterile saline was used to distend the endometrial cavity. Posteriorly and midline at the uterine fundus, a
triangular-shaped 3.5 x 3.0 mm echogenic nodular focus was demonstrated. This was avascular and did not appear to move with agitation. Separately seen from this at the left cornual region was a band-like density with an arc-like appearance in the endometrial cavity. The lower uterine segment appeared unremarkable.

IMPRESSION:
1. Complex right ovarian cyst for which six-week follow-up sonography is suggested.
2. Hysterosonography suggests a 3.5 x 3.0 mm triangular-shaped
echogenic avascular nodular structure at the uterine fundus posteriorly in the midline. I cannot exclude an endometrial polyp.
3. Band-like density was shown in the left cornual region resembling a
synechium. The differential diagnosis would include a strand of mucus.
For further assessment, consideration of hysteroscopy suggested.

3. Sample Report:

HYSTEROSALPINGOGRAM

History: Infertility
Hysterosalpingogram
Fluoroscopic guidance was provided in the performance of this examination. The uterine cavity is within normal limits. Both fallopian tubes are normal and there is free intraperitoneal spillage of contrast bilaterally. The isthmus is within normal limits measuring
approximately 5 mm in transverse diameter.
Impression: 1. Normal HSG with bilateral tubal patency

Arthrogram:-

Arthrogram involves injecting dye into joints such as the shoulder knee hip wrist and elbow. The contrast may be either gadolinium or iodine or a combination of two. An initial exam is performed in the fluoroscopic room for injecting the contrast further imaging is performed in CT or MRI room.

IR( interventional radiology)-3-Arthrogram

Arthrogram

If there is no interpretation --code Guidance- Fluoroscopy (77002) or CT (77012).

CODE	Description	S&I
27648	Ankle
23550	shoulder	73040
23769	knee	73580
27093	Hip w/o anesthesia	73525
27095	Hip with anesthesia	73525
24220	Elbow	73085
25246	wrist	73115
27648	Ankle	73615

1.Sample Report:

MRI Shoulder (R) Post Arthrogram:

CLINICAL INDICATION: Complete rupture of the left shoulder rotator cuff, right arm pain.
TECHNIQUE: TECHNIQUE: Risks including but not limited to infection and bleeding were explained and informed consent was obtained. The patient was placed on the table and 1% Lidocaine was administered after observing sterile precautions. Under fluoroscopic guidance, a needle was inserted in the shoulder joint capsule. The contrast was injected with a mixture of gadolinium, iodinated contrast, and saline. Following this, the needle was removed. There were no complications. Images were obtained. The patient was sent to MR after conventional images were obtained.
IMPRESSION
Right shoulder arthrography performed, 15 cc of a mixture of saline, Gadolinium, and iodinated contrast was injected. Full-thickness rotator cuff tear confirmed with a tear in the distal portion of the rotator cuff with contrast extravasating into the subacromial/subdeltoid recess.

2. Sample Report:

ARTHRO PRE-MRI WRIST PANEL

PROCEDURE: Left wrist arthrogram.
INDICATION: Pain.
DESCRIPTION:
The procedure and its possible complications were explained to the patient. The patient gave consent. The skin of the left wrist was prepped and infiltrated with lidocaine 1%. With fluoroscopy guidance, a 26-gauge needle was used to enter the radiocarpal joint space. This is followed by an injection of 9 ml of Omnipaque and gadolinium mixture. The needle was removed. Spot films of the wrist were obtained. The patient tolerated the procedure. The patient was then taken to the MR suite for an MRI post arthrogram study. Fluoroscopy time is 1.1 minutes.

IMPRESSION:
Left wrist arthrogram performed. For further detail, please refer to MRI from the same day.